Yes! I would like to support
Positively Pink Packages
in caring for breast cancer patients.

(   ) $1000
(   ) $500
(   ) $100
(   ) $75
(   ) $50
(   ) $25
(   ) Other _____________

 If this gift is given in honor/in memory please fill out below:

This gift is given:
In honor of: __________________________________________

In memory of: ________________________________________

Please notify:
Name: _____________________________________________

Address: ___________________________________________

___________________________________________________

Please return this form with your tax deductible check to:

Positively Pink Packages
PO Box 208
Fayetteville, NY 13066